title: Cost effectiveness of using surgery versus skeletal traction in management of femoral shaft fractures at Thika level 5 hospital, Kenya.
abstract: BACKGROUND
  A prospective quasi experimental study was undertaken at the Thika level 5 hospital. The study aimed to compare the costs of managing femoral shaft fracture by surgery as compared to skeletal traction.
  
  
  METHODS
  Sixty nine (46.6%) patients were enrolled in group A and managed surgically by intramedullary nailing while 79 (53.4%) patients were enrolled in group B and managed by skeletal traction. Exclusion criteria included patients with pathological fractures and previous femoral fractures. Data was collected by evaluation of patients in patient bills using a standardized questionnaire. The questionnaire included cost of haematological and radiological tests, bed fees, theatre fees and physiotherapy costs. The data was compiled and analyzed using SPSS version 16. Person's chi square and odds ratios were used to measure associations and risk analysis respectively.
  
  
  RESULTS
  A higher proportion of patients (88.4%) in group A were hospitalized for less than one month compared to 20 patients (30.4%) in group B (p, 0.001).Total cost of treatment in group A was significantly lower than in group B. Nineteen (27.9%) patients who underwent surgery paid a total bill of Ksh 5000-7500 compared to 7(10.4%) who were treated by traction. The financial cost benefit of surgery was further complimented by better functional outcomes.
  
  
  CONCLUSIONS
  The data indicates a cost advantage of managing femoral shaft fracture by surgery compared to traction. Furthermore the longer hospital stay in the traction group is associated with more malunion, limb deformity and shortening.
authors.affiliation: Jomo Kenyatta University of Agriculture and Technology, College of Health Sciences, Nairobi, Kenya.
authors.forename: Everisto
authors.initials: E
authors.lastname: Opondo
authors.forename: Peter
authors.initials: P
authors.lastname: Wanzala
authors.forename: Ansellimo
authors.initials: A
authors.lastname: Makokha
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D003362:Cost-Benefit Analysis; D005260:Female; D005264:Femoral Fractures / Q000191:economics* / Q000601:surgery / Q000628:therapy; D005594:Fracture Fixation, Intramedullary / Q000191:economics* / Q000379:methods; D017759:Fractures, Malunited / Q000453:epidemiology; D017722:Hospital Charges / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007630:Kenya; D007870:Leg Length Inequality / Q000453:epidemiology; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014143:Traction / Q000191:economics* / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
keywords: Fracture shaft femur; cost effectiveness; functional outcome